Health briefs report on the latest studies

Study finds big jump in doctor's office visits for young adults with diabetes

E.J. Mundell, HealthDay

A new report finds that by 2010, one in every 10 visits Americans made to their doctor's office involved diabetes, with the greatest rise among those aged 25 to 44.

Data from the U.S. Centers for Disease Control and Prevention found the number of office visits for patients with diabetes in this age group jumped by 34 percent between 2005 and 2010.

Almost 29 million Americans have diabetes, the CDC said, and managing the blood sugar disease costs almost $245 billion each year. Diabetes falls into two categories: Type 1, which is typically inherited and comprises about 5 percent of cases, and type 2, which is closely tied to obesity and makes up 95 percent of cases.

Overall, the new report from the CDC's National Center for Health Statistics (NCHS) found that office-based visits for diabetes patients rose by 20 percent — from 94.4 million in 2005 to 113.3 million in 2010.

Since diabetes is linked to other conditions such as heart disease, vision trouble and stroke, many of these visits involved treatment for multiple problems, the report found.

One expert wasn't surprised.

"Eighty-seven percent of visits to physicians by patients with diabetes were made by patients with multiple chronic conditions," said Dr. Jeffrey Powell, chief of the division of endocrinology at Northern Westchester Hospital in Mt. Kisco, N.Y.

"Approximately 35 percent of visits made by patients age 45 and over were by patients with four or more chronic conditions," he added. "This means that in addition to addressing diabetes, physicians have to consider multiple other medical conditions that the patients have as well. This becomes difficult to do in one office visit."

The CDC report, published July 31 in the NCHS Data Brief, also found that treatment got more complicated as people aged.

"Five or more drugs were continued or prescribed at 60 percent of the visits by patients with diabetes age 65 and over," Powell said. "This suggests that as people with diabetes get older, they have to take multiple medications. There is a significant financial burden to patients, plus this 'polypharmacy' can increase the chance that all of the medications will not be taken exactly as prescribed."

Another expert was alarmed by the findings in the young adult age group.

The new report "demonstrates that diabetes is no longer a disease of older patients," said Dr. Alyson Myers, an endocrinologist at North Shore University Hospital in Manhasset, N.Y.

Type 2 diabetes has "become prevalent in adolescence with the ongoing obesity epidemic," she noted.

Myers also said it was "unsurprising to note that older patients have the greatest volume of visits," since they often have multiple chronic conditions. These may include high blood pressure, kidney trouble, high cholesterol levels and heart disease.

Mummy study shows no TV or obesity, but ancient people still had heart disease

Amy Norton, HealthDay

They may not have had fast food, TVs or cigarettes, but people of ancient times commonly developed clogged heart arteries — and a new research review speculates on some reasons why.

Using CT scans of mummified remains from ancient Egypt, Peru, the Aleutian Islands and the American Southwest, researchers have found evidence of widespread atherosclerosis — the hardening of heart arteries from fatty substances that build up, eventually leading to heart attack or stroke.

That's despite the fact that those ancient groups were largely free of today's perilous lifestyle factors, such as sugar- and fat-laden diets, inactivity, smoking and widespread obesity.

"Our team has evaluated mummies from five different continents. We have yet to find a culture that didn't have atherosclerosis," said cardiologist Dr. Gregory Thomas, the lead author of a review published in the current issue of the journal Global Heart.

So, what does that mean for modern times? "These days, we blame ourselves when we or someone in our family develops heart disease," said Thomas, medical director of the Memorial Care Heart & Vascular Institute at Long Beach Memorial Medical Center in California.

"We say, 'Well, if you'd just exercised more, you wouldn't have needed that heart surgery,'" Thomas said. "I think people can stop blaming themselves so much."

But before you hang up your running shoes and settle down with a bag of chips, Thomas also said that lifestyle still matters. "This doesn't mean we should stop trying to control risk factors for heart disease," he stressed.

Just don't expect to remain free of heart trouble simply because you jog every day or eat a healthier diet, Thomas said.

Based on what he and an international research team have seen, slightly more than a third of 76 Egyptian mummies had atherosclerosis — and so did a similar percentage of mummies from Peru, the U.S. Southwest and the Aleutian Islands, in the Northern Pacific.

They typically died in what would be considered middle-age today. "It seems like they developed atherosclerosis around the same time that we get it today," Thomas said. So part of the explanation, he noted, may be age: If you live long enough, fatty deposits will start to build up in the arteries.

Genes are another major factor. "Genetics may account for about half of the risk of heart disease," Thomas said. "We all have some genetic predisposition to atherosclerosis, regardless of culture or lifestyle."

But the researchers also speculate about some environmental causes during ancient times. One is exposure to household smoke from cooking fires. Another is the host of infections people were constantly battling — from short-lived bacterial and viral infections, to lifelong parasitic ones.

Thomas explained that even when people managed to survive those ills, the body would be in a continual state of low-grade inflammation, which is part of the immune system's response to invaders.

And that's in line with what scientists today suspect: Chronic inflammation contributes to atherosclerosis.

It's just that today, the primary causes of that inflammation may be different, said Dr. Suzanne Steinbaum, director of Women's Heart Health at Lenox Hill Hospital in New York City.

Modern factors may include diet and sleep loss — but there could be a range of yet unknown contributors, according to Steinbaum, who was not involved in the new research.

"This study reminds us that we need to keep looking at aspects of modern life that could be contributing to inflammation," Steinbaum said.

Thomas acknowledged that in Egypt, mummification was an elaborate and expensive process. So those remains would represent the upper class at the time — people who might have enjoyed indulgent diets and ample lounging time.

But Thomas said the remains from some other cultures likely represent the "common person" — such as the Aleutian hunter-gatherers, who probably did not spend much time lounging and eating.

Researchers says teen 'growing pains' may persist for years

Mary Elizabeth Dallas, HealthDay

Many teens never outgrow their "growing pains," according to new research.

Knee pain can persist for years, affecting teens' participation in sports and other activities, a Danish study found. If left untreated, so-called growing pains can become chronic, the researchers cautioned.

"We can see from the study that one in three young people between the ages of 12 and 19 experience problems with pain in their knees," said Michael Skovdal Rathleff, a physiotherapist from Aarhus University. "Seven percent of the adolescents experience daily knee pain in the front of the knee. More than half still have problems after two years, so it is not something they necessarily grow out of."

The study involving 3,000 teens revealed knee pain is a more significant problem than previously thought. Young people with knee pain may stop playing sports because of their discomfort. Without treatment, their quality of life may suffer, the researchers cautioned.

"If knee pain is not treated there is a high risk of the pain becoming chronic. And this clearly has a big consequence for the individual's everyday life and opportunities," Rathleff noted in a university news release. "Our findings show that these adolescents have as much pain symptoms and reduced quality of life as adolescents on a waiting list for a cruciate knee ligament reconstruction, or as a 75-year-old six months after receiving a new knee."

Previous research has shown that about 25 percent of patients who've undergone a knee replacement because of osteoarthritis of the kneecap also had knee pain since they were teenagers. Osteoarthritis of the kneecap, the researchers concluded, may sometimes begin early in life. They added, however, that earlier treatment and proper training could help.

Pain resolves with the right training in up to half of the young people with knee pain, according to the study published recently in BMC Pediatrics. But following through on treatment may be a challenge for many teens, the researchers noted.

"It is worrying that the pain only disappears in the case of half of the young people who actually do the training," said Rathleff. "The indications are that we should start the treatment somewhat earlier where it is easier to cure the pain."

This doesn't mean all teens with bad knees must visit a physical therapist, he added. Closer cooperation between physical therapists and general practitioners about how to best help these young people could also be a solution, he said.

Experts say civilian life, not combat, may drive many veterans to drink

Steven Reinberg, HealthDay

Difficulties in civilian life, rather than war experiences, are a source of drinking problems among U.S. National Guard soldiers back at home, a new study suggests.

Setbacks such as job loss, divorce and financial problems — all common for returning vets — may make as many as 13 percent of vets turn to drink, researchers found.

"Exposure to combat-related traumatic events has an important effect on mental health in the short term, but what defines long-term mental health problems among Guardsmen is having to deal with a lot of daily life difficulties that arise in the aftermath of deployment when soldiers come home," said lead researcher Magdalena Cerda, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.

These difficulties don't just aggravate existing drinking problems; "they may lead to new cases of alcohol use disorder," Cerda said. "To prevent the problem of alcohol abuse in the military from growing, we need to help Guardsmen who return home to find jobs, rebuild their marriages and their families, and reintegrate into their communities."

Nearly 7 percent of Americans have drinking problems, but the rate of alcohol abuse is twice that for reserve soldiers returning from deployment, according to background information in the study.

Rachel Yehuda, a professor of psychiatry at the Icahn School of Medicine at Mt. Sinai in New York City, agreed more attention should be paid to reservists after deployment.

"We need to make sure that we support veterans through homecoming and readjustment to civilian life, because it seems like those are the stressors that might contribute to alcohol abuse," she said.

"The findings also remind us that even though our soldiers put themselves in harm's way and are exposed to multiple life-threatening events and losses during deployment, the military environment may offer a type of social support that is protective against self-damaging behaviors," Yehuda added.

For the study, published online July 31 in the American Journal of Preventive Medicine, researchers collected data on about 1,000 Ohio National Guard soldiers who had served in Iraq or Afghanistan in 2008 and 2009.

Over three years, the soldiers were interviewed three times and asked about their alcohol use. They also were asked about exposure to traumatic events, such as land mines, vehicle crashes, enemy fire and the deaths of fellow soldiers. They answered questions about their own injuries and about stressors in their lives since returning.

Among these veterans, six out of 10 had experienced combat-related trauma, 36 percent had experienced problems since returning, and 17 percent said they were sexually harassed during their most recent deployment.

In addition, 13 percent reported alcohol abuse or dependence during their first interview, 7 percent at the second interview and 5 percent during the third interview, the researchers said.

Cerda found that having at least one civilian stressor or an incident of sexual harassment during deployment increased the odds for alcohol problems among those who hadn't abused alcohol before. Combat-related events, however, were not strongly associated with alcohol problems.

Mark Kaplan, a professor of social welfare at the Luskin School of Public Affairs at the University of California, Los Angeles, said re-entering civilian life after deployment can be "quite tough."

"Perhaps we have stressed mental health problems too much and what we need more of is an emphasis on the psychosocial circumstances," he said.

Kaplan said having social workers or professionals work with military families could help veterans readjust to life back home.

"Many are not prepared for departure to combat and many are not prepared to cope once they return," he said.

Study finds cold sore virus active without symptoms

Mary Elizabeth Dallas, HealthDay

The virus that causes cold sores — herpes simplex type 1 — remains active even in the absence of symptoms, according to a new study.

Researchers in Australia found there's an ongoing struggle in the cells of people infected with the virus. This explains why some people with the virus never develop cold sores and why others get them only occasionally. The authors said the findings could lead to the development of new treatments.

"We thought when the disease was dormant, it was a truce. It turns out that the virus is waking up more often than we thought, but our cells are constantly pushing it down," said David Tscharke, associate professor in the Research School of Biology at Australian National University.

"When we thought there was nothing going on we had no targets to look at. Now that we know there is an interaction, we can look for ways to help the good guys to win," Tscharke said in a university news release.

In conducting the study, published July 24 in PLOS Pathogens, the researchers used cells and viruses that were genetically modified so infected cells turned bright yellow even when the virus was inactive. This allowed the infected cells to be identified. Then, using a microscope equipped with a laser, the scientists measured levels of viral activity in the cells.

"We expected that we would see no activity in the dormant cells," Tscharke said. "The surprise came when we found the virus was doing something in many cells."

Cells also have different levels of viral activity, the researchers found. "For some it's very low and in others more of the virus genes are turned on. The host cells were responding most strongly when there was lots of virus activity," Tscharke said.

Study finds preschoolers with special needs may gain from 'inclusion' classrooms

Mary Elizabeth Dallas, HealthDay

Preschoolers with special needs benefit from going to school with children who have strong language skills, according to a new study.

Classmates with higher-level language abilities promote language growth in children with disabilities, researchers found. On the other hand, development of language could be delayed if their classmates have weak language skills, they said.

"We were surprised to see the striking differences among children's language skills at the end of the school year when considering those with less-skilled peers and highly skilled peers," said the study's lead author, Laura Justice, psychological scientist with the Crane Center for Early Childhood Research and Policy at Ohio State University in Columbus. "In particular, children with disabilities seemed to be very negatively affected by having classmates who were less skilled."

The researchers said the findings, published July 28 in Psychological Science, support the concept of inclusion — including children of varying abilities in a classroom.

The study involved 670 preschoolers. More than 50 percent of the children were diagnosed with a disability, such as autism spectrum disorder, language impairment or Down syndrome.

At the beginning of the school year, teachers assessed the children's language skills. Their development was reassessed at the end of the year to determine how much their abilities improved. The researchers also compared each child's end-of-year score with the classroom average.

Preschoolers with special needs were more affected by their classmates' language skills than the kids who did not have a disability, the study revealed. By the end of the school year, the special needs children in class with other children with weak language skills lagged well behind their normally developing peers.

In contrast, the preschoolers who had weak language skills when the school year began had greater improvements throughout the year if their classmates had strong language skills. The researchers pointed out these kids had scores similar to highly skilled students who had less-skilled peers.

When kids are in a classroom together, they naturally imitate each other's behavior, the researchers explained. This encourages the development of language skills, such as waiting to speak, communicating needs and storytelling.

"If peer effects operate as our work suggests they do, it is very important to consider how to organize children in classrooms so that their opportunities to learn from one another is maximized and so that young children with disabilities are not segregated into classrooms serving only those with special needs," Justice said in a journal news release.

Since the language skills of normally developing children continue to improve regardless of the abilities of their classmates, the researchers concluded school officials should strive to fill classrooms with students of various skill levels.

Study finds 1 in 4 U.S. kids underestimate their weight

Steven Reinberg. HealthDay

Many obese and overweight kids don't see themselves that way, which makes achieving a healthy weight almost impossible, researchers report.

In a new study, 27 percent of children and teens underestimated their weight. Fewer than 3 percent overestimated it. About 25 percent of parents underestimated their child's weight and just 1 percent overestimated it, according to the study.

"Efforts to prevent childhood obesity should incorporate education for both children and parents regarding the proper identification and interpretation of actual body weight," said lead researcher Han-Yang Chen, from the department of quantitative health sciences at the University of Massachusetts Medical School in Worcester, Mass.

"Interventions for appropriate weight loss should target children directly because one of the major driving forces to lose weight comes from the child's perception of their weight," he said.

The report was published July 31 in the journal Preventing Chronic Disease.

Dr. William Muinos, director of the weight management program at Miami Children's Hospital, said, "I see weight misperception all the time."

Parents don't understand why their child is overweight or obese, he said. Parents think their child has a glandular problem or they will outgrow obesity. "That's nonsense, because obese kids are likely to stay obese," Muinos said.

Children can misperceive their weight if all the people they see are obese or overweight, he said. "If everyone you're around in your family and your social world is obese or overweight, then you are one big happy family. And you see that in our country," Muinos explained.

For the study, Chen's team used data from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Survey to assess weight perceptions. The surveys included more than 2,500 kids aged 8 to 15 years.

The researchers found that the odds of trying to lose weight was nearly 10 times higher among participants who overestimated their weight than among those who perceived their weight accurately. Those who underestimated their weight were the least likely to attempt to lose weight, according to the study.

Parental misperception of weight was not associated with attempts to lose weight among children and teens who were overweight or obese, the investigators found.

Dr. David Katz, director of the Yale University Prevention Research Center, takes a broader view of the problems of weight perception.

"Above all, this study highlights the perils of a societal preoccupation with weight, rather than a focus on health and the lifestyle factors that support it," he said.

Eating well and being active are important regardless of weight because they promote health, he said. "Weight is merely one among many measures that suggest something about overall health, albeit an important one," Katz said.

The high rate of dieting among children who overestimated their weight is of real concern, he noted. "This behavioral pattern suggests impaired body image perception and vulnerability to eating disorders," Katz said.

The more common problem of underestimating weight and its effect on lowering the likelihood of weight control efforts is also concerning, he added.

"These opposing problems are really two sides of the same coin — the fixation on weight rather than health. In general, dieting is ill advised, both for overweight children and those misperceiving their weight as high when it isn't," Katz said.

Eating well and being active are recommended for both groups and all other children, he said. "We do need to raise awareness about the importance of childhood obesity, but we need to emphasize that what really matters is health," Katz explained.

"If a devotion to healthful behaviors was the norm in our culture, and not the perception of weight, we would not talk our children into dieting they do not need, or out of weight control efforts they do need," he said.

Muinos added that parents need to be educated about the importance of healthy eating and exercise as well as the dangers of obesity.

Getting children to eat well and exercise needs to be a family effort, Muinos said. "You cannot isolate the child who is obese. The whole family has to be involved both in exercise and diet," he said.

Study finds kids' lunch boxes often fall short on nutrition

Tara Haelle, HealthDay

A home-packed lunch isn't necessarily healthier than school cafeteria fare, a new study suggests.

The new research found that just 27 percent of the lunches third and fourth graders brought from home met three of five National School Lunch Program (NSLP) standards.

"Our findings are similar to results of other studies of children's packed lunches from across the world, which have found that high-calorie packaged foods and beverages are more common than fruits, vegetables and dairy," said Kristie Hubbard, a research associate at the Friedman School of Nutrition Science and Policy at Tufts University in Boston.

A quarter of the lunches did not have a primary entree, such as a sandwich or leftovers, and most of these lacked yogurt, cheese, peanut butter or another protein instead of an entree. Only a third of the packed lunches included fruit, and 11 percent included vegetables, yet a quarter included sugar-sweetened beverages.

Among the 42 percent of lunches with snack foods, the most common packaged foods were chips, cookies and candy, Hubbard said.

The typical snack brought for snack time was a sugar-sweetened beverage and a snack food or dessert. Only 30 percent of snacks were fruits, and only 10 percent included dairy foods.

"Perhaps people should not be so quick to judge school lunches because this is worse," said Lona Sandon, a registered dietitian and assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. "What students are bringing from home is not better than what's being offered in schools."

Approximately four out of 10 youngsters bring their lunches to school instead of buying school cafeteria meals, according to the study.

For the current research, packed lunches and/or snacks of more than 600 third and fourth graders were photographed and cataloged. Parents consented to the study, but were not notified ahead of time of the exact day the researchers would look at their child's lunch.

On the day in question, nearly half the students brought lunch from home. Almost all of them also brought a snack. The other 325 students brought only a snack and planned to buy a school lunch.

Just over one in four lunches met a majority of the school lunch standards set for cafeteria meals. These standards call for a half a cup of fruit (excluding juice), 3 / 4cup of vegetables, 1 ounce of grains, 1 ounce of meat/protein and 1 cup of milk.

Fifty-nine percent of kids brought a sandwich, the most commonly packed lunch food, according to the study. Water was the beverage of choice for 28 percent of lunches, according to the study.

A parent's education level didn't seem to make a difference as to what food was packed. More than 80 percent of the students' mothers had college educations or higher, noted Sandon.

"Often times we think higher education level in mothers would translate into better nutrition practices, but this is not necessarily the case," said Sandon. "It's important to get this information out there to help make parents aware that they may not be making the best choices for their kids."

Parents also face several challenges in packing healthful lunches for their children, she said. The parents may be time-crunched and need to pack food that does not require refrigeration or reheating, perhaps accounting for the high proportion of prepackaged foods.

"Convenience of preparation and convenience of nonperishable items are largely what they're thinking when they put things together," Sandon said.

Yet there are still ways to swap a high-calorie, less-nutritious food for a healthier option.

"The Dietary Guidelines for Americans recommend a balance of fruit, vegetables, whole grains and low-fat dairy as the building blocks of healthy meals," Hubbard said. "Making small changes over time, such as switching to whole grain bread, adding lettuce to a sandwich or replacing cookies with a favorite fruit, can go a long way toward better nutrition."

Sandon added that easy-to-eat fruits and vegetables, such as apples, grapes, bananas and carrot sticks, hold up well, as do no-sugar-added prepackaged fruit cups and low-fat string cheese.

The study was limited because the data came from mostly white, higher-income participants. Further, the researchers do not know who -- parents, students or someone else -- packed the lunches or what the children actually ate at lunch.

The research, funded by the Boston Nutrition Obesity Research Center and the National Institutes of Health, was published online recently in the Journal of the Academy of Nutrition and Dietetics.

Report finds some jobs harder on the heart than others

Steven Reinberg, HealthDay

Stress at work may raise your risk of heart attack and stroke, particularly if you work in the service industry or have a blue-collar job, U.S. health officials reported Thursday.

But being unemployed might be just as unhealthy, they added.

"Workplace factors that increase risk include job stress, exposure to air pollution -- like dust and secondhand smoke -- and noise," explained lead researcher Dr. Sara Luckhaupt, from the National Institute for Occupational Safety and Health, part of the U.S. Centers for Disease Control and Prevention.

Some workers may already have other risk factors for stroke and heart attack, such as high blood pressure and cholesterol, which can be made worse by workplace stresses, Luckhaupt explained. In fact, the researchers found that 1.9 percent of workers under 55 reported a history of heart disease and stroke.

"It's probably a combination of personal and work factors," she said.

"Don't forget the job factors," Luckhaupt said. "The noise, the air pollution and job stress could be contributing to the personal risk factors, like difficulty quitting smoking."

Unemployed workers, however, weren't spared, she noted. Among unemployed people looking for work, the rate of heart attack and stroke was also high — 2.5 percent.

"It may be that the stress of unemployment and the lack of access to health care may be contributing to their health problems," she said.

However, whether these workers have health problems because they are unemployed or if they are unemployed because of health problems isn't known, Luckhaupt said. While the report found an association between employment stress and heart health, it did not prove a cause-and-effect link.

For the study, published in the Aug 1 issue of Morbidity and Mortality Weekly Report, the researchers compiled data from the 2008-2012 National Health Interview Survey.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, "There is increasing interest in workplace-based disease prevention, health promotion and wellness programs as a means of improving health."

As heart disease and stroke remain the leading causes of death in men and women in the United States, prevention strategies and workplace health programs are essential, he said.

"Health professionals, employers and workers should take proactive steps to improve their heart health, implement and take advantage of comprehensive workplace wellness programs and better utilize effective interventions to prevent heart disease and stroke," he said.